Monthly Archives: May 2010

I had an experience recently to renew my excitement to help transform hospitals with Lean. Our son’s pediatrician is helping us deal with his colic. The doctor said he wants to try one change at a time to determine what will help my boy. This is Plan-Do-Check-Act!

Some organizations want to implement a ton of stuff at once. If the problem is fixed, it is difficult to pinpoint which of the myriad of countermeasures did the trick. If the problem is not fixed, they throw a bunch more changes to the wall to see what sticks.

Our pediatrician patiently tries one thing at a time. Once the issue is resolved, he will then begin removing some of the counter-measures (medication and other soothing techniques) and continue to check that the colic is still gone. How often do organizations remove some of the counter-measures after they implement a bunch at once?

PDCA is scientific thinking and doctors use it. My excitement is renewed because I see how using PDCA with providers will help make Lean relevant for them in hospitals.

I am now back from my wonderful 4.5 weeks of paternity leave and am more committed than ever to help hospitals become lean. Through the birth and follow-up pediatrician visits, I have been a customer of health care and see many opportunities for staff and patient satisfaction. Here are some of the things I experienced:

New IV Ports – One nurse had trouble connecting an IV port on my wife during labor. She exclaimed “they changed our ports a few months ago but we kept on using the old ones. Now the old ports have been thrown away and we are forced to use the new ones. I don’t see why they switched them.” Another RN mentioned the ports later and said “I was on vacation when the ports changed so I never got the training for how to use them”.

Lack Of Patient Centered Care – Our OB seemed to have an agenda on the day of labor and increased medications without telling us first despite our birth plan and previous conversations requesting informed consent for things like this. The OB was using scare tactics to push for a c-section without explaining pros and cons for alternatives.

Pediatrician Office Visit Late – For our one month check-up the pediatrician was 20 minutes late. The doctor looked visibly flustered and distracted. He apologized for running late and expressed how bad he feels to be running behind and hates to make people wait.

What Is Up With Our Hospital Bill? – The day before we discharged, a person provided an estimated amount and asked for a credit card. A month later we get a bill in the mail for half the amount we already paid without any indication our initial payment was credited towards anything. I called their billing customer support only to be told the initial credit card amount was applied later in the day that my bill was mailed. The rep told me the lower bill we got in the mail was incorrect and we really owed the larger amount we originally paid for with a credit card (plus an additional $68).

Lean transformations can help each of these situations. Using better training, job instruction sheets, and explaining why would help the nurses with their ports (although I question what prompted the change if they were allowed to use the old ports for a few months if someone claimed safety was the reason). Helping providers understand what their patient’s wants and needs are will allow them to better serve their community and will most likely help with growth. Doctors can have reduced stress and better engagement if the root causes for being late for appointments are improved. Lastly, recognition that the patient experience usually ends once everything is paid can help improve billing accuracy/clarity and save money from rework due to patients calling in to ask about their bill.

With renewed energy and passion I return to work to help those in hospitals see the opportunities all around them while providing guidance for how to capitalize on them.